Provider Demographics
NPI:1124264700
Name:PORTER, WILBUR FRANKLIN (LPN)
Entity type:Individual
Prefix:MR
First Name:WILBUR
Middle Name:FRANKLIN
Last Name:PORTER
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15514 TALFORD AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44128-1227
Mailing Address - Country:US
Mailing Address - Phone:216-751-0320
Mailing Address - Fax:
Practice Address - Street 1:15514 TALFORD AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44128-1227
Practice Address - Country:US
Practice Address - Phone:216-751-0320
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-01
Last Update Date:2009-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN 115191164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse